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Insurance Claims Specialist
$39,520 - $43,680/Yr
Nursedeck - Rancho Mirage, CA
posted 3 months ago
Full-time - Entry Level
Rancho Mirage, CA
About the position
The Insurance Claims Specialist position involves managing and processing insurance claims while ensuring compliance with hospital policies and regulations. The role requires effective communication with patients and insurance payers to resolve outstanding accounts and maintain accurate records of account statuses. This position is contract-based and operates Monday to Friday in Rancho Mirage, CA.
Responsibilities
- Ensure compliance with Code of Conduct and hospital policies.
- Manage new accounts daily via Receivables Workstation, interfacing with hospital departments as needed to resolve claims.
- Contact patients and account guarantors to solicit payments on outstanding accounts.
- Process accounts in the Follow-Up queue daily, including telephoning payers and utilizing payer websites.
- Stay updated on payer requirements and processes, using bulletins, provider handbooks, and websites.
- Record insurance plans and facilitate account processing in accordance with pre-billing policies.
- Maintain accurate, detailed notes on account statuses, issues, and expected resolution dates.
- Escalate account issues to the Supervisor when necessary.
- Handle credit balance accounts and prepare necessary adjustments or refunds.
- Complete special projects assigned by management (e.g., high-dollar accounts, accounts over 180 days old).
- Analyze inventory aged over 90 days and provide analysis reports to PFS management to decrease AR days.
- Process incoming explanations of benefits and ensure timely resolution.
- Maintain productivity standards and resolve denials, payer rejections, and delayed payments.
- Attend training sessions on Federal and State billing regulations and compliance issues.
- Stay current on insurance payer updates and relay the information to management and colleagues.
Requirements
- Experience with managed care, Medicare/Medi-Cal billing regulations.
- Knowledge of compliance regulations and medical billing/coding.
- Strong customer service and communication skills.
- Effective time management and organizational skills.
- Ability to work collaboratively in a team environment.
Nice-to-haves
- Experience in medical coding.
